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Poster Display session 1

2950 - Delayed Onset Immune Related Adverse Effects (IRAEs) of Pembrolizumab in Non-Small Cell Lung Cancer

Date

28 Sep 2019

Session

Poster Display session 1

Topics

Tumour Site

Non-Small Cell Lung Cancer

Presenters

Haixi Yan

Citation

Annals of Oncology (2019) 30 (suppl_5): v602-v660. 10.1093/annonc/mdz260

Authors

H. Yan1, Y. Jiang2, M.K. Luong3, N. Naban4, C. Kane2, J. Conibear5, D. Papadatos-Pastos4, T. Ahmad3, D. Chao1, U.S. Asghar3, G. Anand1

Author affiliations

  • 1 Oncology, North Middlesex University Hospital NHS Trust, N18 1QX - London/GB
  • 2 Oncology, St. Bartholomew's Hospital, EC1A 7BE - London/GB
  • 3 Medical Oncology, University College London Hospital, NW1 2BU - London/GB
  • 4 Oncology, The Princess Alexandra Hospital, CM20 1QX - London/GB
  • 5 Radiotherapy Department, St. Bartholomew's Hospital, EC1A 7BE - London/GB

Resources

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Abstract 2950

Background

The humanised PD1 antibody, Pembrolizumab, is used as monotherapy in the 1st and 2nd line setting for patients with advanced non-small cell lung cancer (NSCLC). There is a lack of data about the delayed onset of IRAEs which is important as patients can be on prolonged treatment.

Methods

This is a retrospective study of NSCLC patients treated with pembrolizumab across 4 institutions in London (North Middlesex University Hospital, Princess Alexandra Hospital, St. Bartholomew’s Hospital and University College London Hospital). IRAEs recorded on clinic letters from start of treatment until March 2019 were categorised as early (<180 days from first dose) or delayed (>180 days).

Results

139 patients (60% male) with advanced NSCLC were treated with pembrolizumab. Median age was 67 years and 75% (104/139) were adenocarcinoma. Median follow up was 191 days with 3 patients completing 2 years of treatment. IRAEs were reported in 53% (73/139) with patients experiencing up to five different IRAEs. 34% (40/116) of all IRAEs were delayed and colitis was the most common (54%) late IRAE, followed by skin & mucosal toxicities (Table). There were no differences in the grade of severity (P = 0.37) or number of toxicities requiring permanent discontinuation of pembrolizumab between early and delayed IRAEs (P = 0.31). All patients with pneumonitis, 88% with hepatitis and 87% with colitis were treated with steroids. In 88% (35/40) of patients with delayed IRAEs, toxicities resolved or became asymptomatic. All but 2 cases of endocrinopathy required chronic hormone replacement therapy. 19 cases of treating through toxicity with maintenance low dose corticosteroid were identified. Of these, only one developed progressive disease with the remainder continuing to receive pembrolizumab.Table:

1510P

IRAEsEarlyDelayed
General e.g. Fatigue172
Rash/Pruritis2311
Colitis1112
Hypo/Hyperthyroidism73
Hepatitis53
Pneumonitis53
Hypophysitis22
Arthritis13
Blepharitis/Conjunctivitis31
Polymyalgia/Myositis21
Nephritis01
TOTAL76 (66%)40 (34%)

Conclusions

Delayed onset IRAEs are common and exhibit a different profile of toxicities compared to early onset. They are no more severe than early IRAEs and can be effectively managed to allow patients to continue their treatment.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

North Middlesex University Hospital, Princess Alexandra Hospital, St. Bartholomew’s Hospital and University College London Hospital.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

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